Panel at Ursinus College looks at the future of health care as it pertains to you

Photo courtesy of Ursinus College
Ursinus College President Bobby Fong introduces the panelists at Tuesday’s discussion “Our Options Have Changed: Consumer Health Literacy in a Changing Environment.” Pictured from left are Kevin Flynn, owner of HealthCare Advocates Inc.; Steven M. Altschuler, CEO of The Children’s Hospital of Philadelphia; keynote speaker Larry R. Kaiser, president and CEO of Temple University Health System, and Rebecca Jaroff, associated professor of English, Ursinus College, who acted as mediator. Not pictured are panelists Karl Stark, health and science editor for The Philadelphia Inquirer; and Robert Sing, staff physician, Springfield Hospital and Crozer Chester Medical Center.

COLLEGEVILLE — The nation’s health care system is broken, we don’t have enough doctors, med students are buried in debt and significant change in the insurance industry is overdue.

Those were among the topics discussed during a panel discussion held at Ursinus College Tuesday night entitled “Our Options Have Changed: Consumer Health Literacy in a Changing Environment.”

Panelists included CEOs of large regional hospital systems (Larry R. Kaiser, president and CEO of Temple University Health System; and Steven M. Altschuler, CEO of The Children’s Hospital of Philadelphia), a family practice owner (Robert F. Sing, staff physician at Springfield Hospital and Chester Crozer Medical Center), a patient advocate (Kevin Flynn, owner of HealthCare Advocates) and a journalist (Karl Stark, health and science editor for The Philadelphia Inquirer). Ursinus English associate professor Rebecca Jaroff acted as moderator.

Kaiser, a heart surgeon, said in a keynote speech that kicked off the panel discussion, that estimates show there could be a shortage of 150,000 physicians in the next 15 years in the U.S. The greatest demand right now is for primary care physicians — a field that has become less popular than others as it’s been proven to be less lucrative than specialties such as neurosurgery.

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Kaiser told the audience of Ursinus business students, science fellows and faculty gathered in the college’s Lenfest Theater that “health care will not succeed without more physicians.”

Medicine will be more of a “team sport” in the future, with nurse practitioners and physician’s assistants doing more routine work and physicians handling more difficult cases, Kaiser said.

He briefly touched on the fact that health care is a political buzzword this election year.

He explained that per the Massachusetts Plan, enacted in 2006, every resident of that state may receive a state-government-regulated minimum level of health care insurance coverage. The plan provides free health care insurance for residents earning less than 150 percent of the federal poverty level. The plan aimed to cover 95 percent of the state’s 500,000 uninsured within a three-year period, but today 200,000 people remain uninsured, according to Kaiser.

“Health care costs (in Massachusetts) are rising much faster than the national average,” Kaiser said. The fact is, he said, “it costs more to take care of poor people.”

In Pennsylvania, 11.4 percent of residents were uninsured as of 2003; nationally, 45 million lack insurance.

“No other country in the world has these numbers,” Kaiser said, noting 34 percent of medicare expenditures are on patients whose incomes are below $25,000 annually, he said.

When the topic was opened up to the panel, Sing, a critical care surgeon specializing in sports medicine, acute care and emergency medicine, added “Medicine is a business. Your education is a business. You have to ask yourself, is the cost worth the investment?”

Sing said medical school graduates immediately face about $250,000 in school loan debt plus the debt they incur during a typical three-year residency.

How is health care changing?

Flynn, the patient advocate, said health care is becoming consumer-centric. “Health care in the future is a shift in thinking ... While as Americans we see it as entitlement, we’re going to have to change that way of thinking. You have to educate yourself and work with the provider, because the doctor is going to be spending less time with you. You have to fight for resources.”

Altschuler, CEO of CHOP, said it will come down to the consumer changing his or her lifestyle to prevent conditions such as obesity, diabetes, and lung disease.

“Ultimately, we have to attack the way that we live, because the way that we live is basically bankrupting our society,” he said.

Kaiser added that two-thirds of the U.S. population is either obese or overweight.

Stark, the Inquirer editor, said “In Philadelphia, they cut out sugary sodas and baked goods in schools and were able to lower the weight of the students over four to five years. It shows it can happen.”

Kaiser said the changes can’t stop in schools, they must be brought into the home as well, and must include physical education.

Flynn said to make the changes stick, there have to be penalties such as those that already exist in some businesses. The companies penalize employees who do not participate in a company wellness program, for instance.

However, Flynn added, most people won’t make a drastic lifestyle change until there’s an emergency, such as a heart attack.

“As a population, we have to stop waiting until there’s an adverse outcome,” he said.

Sing noted that he sees a lot of obese patients, and educating them “doesn’t work.” Also, he said, “diabetes is huge.”

“There’s got to be a system of incentivizing, where they get some sort of return,” he said, recalling patients who trained for a group bike ride for charity. “People have to start taking responsibility for themselves. I just don’t know how they are going to do it. Working out for being healthy is not enough of a reason.”

What can consumers do to make their voice heard?

Kaiser said it is helpful to know what questions to ask your physician, and most people are proactive.

“Patients come in much more sophisticated than in the past,” Kaiser said, noting that anyone can see just about any procedure — including brain tumor removal — on YouTube.

Flynn said with all the research on the Web, sometimes the patients know more about the latest treatments than the doctors do. He recommended sending information about a new or experimental procedure ahead so the doctor has time to review it before your appointment.

Sing said often the patient thinks they know better than the doctor, such as when a patient with sinusitis comes to see him demanding an antibiotic, when that’s not the course of treatment he’d recommend. That patient might choose to leave the practice if he/she doesn’t get that prescription.

How do we attract primary care physicians?

Kaiser said in other countries, such as Canada, the government decides which specialty a medical student can pursue. Here in the U.S., we have a glut of neurosurgeons and not enough primary care doctors.

“It’s likely physician remuneration is going to decrease,” he said “But most of us don’t go into it for compensation.”

Flynn said more patients will be required to pay copays or deductibles up front. “We will see more of ‘Pay your portion up front or we’re not going to see you.’”

What can we expect under the Affordable Care Act of 2010 (more commonly known as Obamacare)?

“The government is expecting a great savings in Medicare after four or five years,” Flynn said.

If people get annual checkups, diseases like cancer will be diagnosed sooner and treated earlier and head off more costly treatment down the line.

The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond, with most changes taking place by 2014.

Stark said 16 million more people will be on Medicaid, but the government will pay 100 percent of the expansion for the first three years. Also, adult children up to age 26 will be able to be insured under their parents’ plan.

Kaiser added, “Under the Affordable Care Act, there will be no uninsured.”

Sing noted that on the flipside, Medicaid reimbursements to doctors are low. “Right now we have a haphazard system,” he said.